New research finds that assisted reproductive technology, or ART, could worsen MS. Here's what you need to know.

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Women with multiple sclerosis (MS) may face risks to their health if they choose to pursue certain infertility treatments, but pregnancy is still an option for women with MS. In fact, pregnancy can reduce the number of MS flare-ups.

Before 1950, most women with MS were advised to avoid pregnancy for fear it would make their MS worse, says Timothy Coetzee, PhD, chief research officer for the National Multiple Sclerosis Society. Research since then has shown the opposite — especially as women enter their second and third trimesters, says Coetzee.

Unfortunately, infertility treatments or assisted reproductive technology (ART) such as in vitro fertilization (IVF) may worsen MS symptoms. For example, a new study from Argentina showed that women with MS who used ART to help them become pregnant found that it made their MS symptoms worse. The research, published in the Annals of Neurology, involved 16 women with MS who underwent a total of 26 ART cycles. Fifteen healthy volunteers and 15 women with MS who were not receiving ART served as controls. About 75 percent of the women with MS found that their MS symptoms worsened with the infertility treatments. More than 70 percent experienced new symptoms, and 27 percent of women found that their existing symptoms became worse.

Lead investigator Jorge Correale, MD, head of neuroimmunology and demyelinating diseases at the Raúl Carrea Institute for Neurological Research in Buenos Aires, believes that women with MS who are considering ART should be told that it could significantly increase their risk for new exacerbations. “Then they can decide what to do,” he says. “They can either continue pursuing natural ways of becoming pregnant or take this risk.” Until this study, Dr. Correale adds, information on this issue was only partially available.

Rhonda R. Voskuhl, MD, director of the multiple sclerosis program at the David Geffen School of Medicine at the University of California, Los Angeles, says that while the number of patients in the Argentinean study is small, it reinforces some previous studies that suggested fertility treatments can cause changes in MS activity.

Dr. Voskuhl says the key difference between this study and others is that it focused specifically on ART, in which women are given drugs called gonadotropin-releasing hormone (GnRH) agonists to stimulate egg follicle production. Also known as luteinizing hormone, GnRH is responsible for the release of follicle-stimulating hormones (FSH), which regulate the release of eggs. GnRH agonists are used to prevent natural ovulation during IVF.

ART with GnRH is not the only infertility treatment available to women. “There are other options,” says Voskuhl, and “if all your options are otherwise equal, you might want to choose another one." However, she adds that she wouldn’t automatically rule out ART with a GnRH agonist if it were your only choice. Each woman has to weigh the risk of worsening her MS versus the benefit of becoming pregnant and decide for herself, she says.

Preparing for What Pregnancy May Bring

Coetzee says that the question raises the possibility of infertility specialists “tweaking ART for someone who lives with MS and is going to have it done.”

If you decide to go ahead with ART, take steps to better manage an MS exacerbation. Because you’ll be at increased risk for a relapse, it’s important that you pay attention to your body and get medical help sooner rather than later if your MS symptoms worsen. As Voskuhl notes, “you need to be aware it’s a possibility and be vigilant about your symptoms."

She also suggests arranging for help in case your MS symptoms worsen after you give birth. “ART can induce a post-partum relapse, so be sure you have the necessary support to care for yourself and your newborn," says Voskuhl.

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